The American Diabetes Association’s Scientific Sessions is here! Until June 16, scientists will present some of the most updated topics, from beta cell replacement to regeneration and glucose and complications trials, all with the result to change things for the type 1 diabetes (T1D) community. Here are Drs. Eric Triplett, Randi Streisand, Hubert Tse and Teresa Rodriguez-Calvo share their key takeaways from day 2, with their commentary in the video and below:
Eric Triplett, Ph.D.
University of Florida, Gainsville, FL
The Microbiome in T1D—Where Are We Now? (or Bifidobacterium, probiotics and a really promising clinical trial!)
The human digestive tract hosts a community of trillions of microbes—called the microbiome—that play an important role in our immune system, and Dr. Triplett gave an exciting talk on his session; all presented on a clinical trial that improves our understanding of the microbiome in T1D. Starting out was Dr. Triplett, who found that genetics plays a major role in the human microbiome. He also found that there were numerous bacteria in people without a genetic risk for T1D, which may be useful as probiotics. Next was Emma Hamilton-Williams, Ph.D., who asked: “Can a dietary supplement improve glycemic control in adults with T1D?” And, although the diet did not seem to make a difference, she did find a bacteria that seems to improve glycemic control: Bifidobacterium. Christopher Stewart, Ph.D., also found that breastfeeding increased the levels of Bifidobacterium in the microbiome.
The last presenter was Max Nieuwdorp, M.D., Ph.D., who presented on a new treatment for T1D: fecal transplantation (yes, we’re talking about poop!). He asked: “Can fecal transplantation improve beta cell function in people recently diagnosed with T1D?” He used donor stool from a healthy person for half of the participants, and self stool for the other half, and the results were remarkable: self stool was better than stool from a healthy person! HbA1c went from 9.3% to 6% to 7%, and it remained for 12 months. What it means for the T1D community: it may be possible to extend the honeymoon period for just diagnosed people.
Randi Streisand, Ph.D.
Children’s National Medical Center, Washington, DC
Diabetes Devices and Digital Technologies—Who Does It Help the Most (and Least)?
Korey K. Hood, Ph.D., discussed “Is One-Size-Fits-All Actually a Bad Approach?,” and the takeaway: No! We have to use patient-centered diabetes care, and we need to see the individual needs of people. He went on to say that clinicians think that people with T1D need to be better educated on all of the technology, but that’s not what the people with diabetes perceive as a barrier; they cite very little confusion as far as technology goes. So we really need to give access to technology for all individuals, and then we need to individualize care from there. Jill Weissberg-Benchell, Ph.D., talked about CGM and pump use, which have been focused on the non-Hispanic, white population. But, she says, we really need to increase the diversity of those with T1D; CGMs and pumps have real use for people of all racial and socioeconomic groups! Kim Spiro, Ph.D., discussed the NICH (Novel Interventions in Children’s Healthcare) program, which have been able to give resources and technology to those youth in underprivileged groups. Dr. Randi Streisand said what everyone was thinking: “Provide access to technology to all!”
Hubert M. Tse, Ph.D.
University of Alabama at Birmingham
Engaging the Immune System to Protect Beta Cells
Hubert Tse, Ph.D., gave a really exciting talk about how to engage the immune system to protect the beta cells. The first talk was from Brian T. Fife, Ph.D., who discussed the immune checkpoints, which are the “brakes” of the immune system, in autoimmune diabetes. PD-L1 inhibitor is typically used as a treatment for cancer, but Dr. Fife showed that PD-L1 is expressed by beta cells, and it might be involved in diabetes progression. Dr. Tse showed how free radicals are involved in innate and adaptive immune responses in T1D. Maria Grant, Ph.D., demonstrated that regulatory immune cells and effector immune cells are different in T1D, and Alberto Pugliese, M.D., highlighted the importance of an immune messenger, called IL-2, and how it can be effective in T1D.
Teresa Rodriguez-Calvo, DVM, Ph.D.
Helmholtz Zentrum München, Germany
Slicing and Dicing—Prohormone Processing in Diabetes
Emily K. Sims, Ph.D., demonstrated that proinsulin—the precursor to insulin—can be detected in most people with T1D, even when we cannot detect C-peptide anymore. So if we can help beta cells convert the remaining proinsulin, we might be able to recover some insulin secretion. Next up was Bruce Verchere, Ph.D., who talked about pro-islet amyloid polypeptide (known as pro-IAPP) processing in T1D, and suggested that the detection of pro-IAPP in the circulation could have value as a biomarker in T1D. Last up was Dr. Rodriguez-Calvo, who showed that proinsulin can be detected in beta cells in individuals with long-standing disease, but maybe it’s not properly processed.